HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
t08 gft Street, Suite 401
Glenwood Sprlngs, CO 81601
19701945-8212
www. ga rfi el d -countv.com
WPE OFGRAOINGtr MAJoR
INVOTVED PARTIES
Property Owner:
tl rrarruon
Phone:t1
; Mailing Address:
EmailAddress:'t]CC{NI
Architect:
Mailing Address;
Email Address:
Engineer:
t Phone:
Phone:6 O -e>
Mailing Address
Email Address:
\D
,1v\{Zt4 ffi
Phone:
-TODT-,r\fC - C{S-tOM?>arzutlnu\:a:l-lEmailAddress:
Mailing Address:
Contractor:
PROJECT NAME AND LOCATION
Project Name
Describe Work:
reA>
\-fLJ ufpx-n o$-)€ Pu':R,LIl]c
lob Address:4hq .-Fffi;a ;$S6v -
Assessor's Parcel Numben
Sub.[ot _Block
Earthwork (square feet):Earthwork (Cubic Yards):(t,/
ALL UTILITIES MUST BE TOCATED PRIOR TO ANY GRADING
Authority. This application for a Building Permit must be signed by the Owner of the property, described above, or
an authorized agent. lf the signature below is not that of the Owner, a separate letter of authority, signed by the
Owner, must be provided with this Application.
Legal Access. A Building Permit cannot be issued without proof of legal and adequate access to the property for
purposes of inspections by the Building Division.
Other Permits, Multiple separate permits may be required: (1) State Electrical Permit, (2) County OWTS Permit,
(3) another permit required for use on the property identified above, e.g, State or County Highway/ Road Access or
a State Wastewater Discharge Permit.
Void Permi!. A Building Permit becomes null and void if the work authorized is not commenced within 180 days of
the date of issuance and if work is suspended or abandoned for a period of L80 days after commencement.
' ':..'/..
-l'':-.-,-'...-..- --..-.-..-.,::
t hereby certify that I have read this Application a nd that the information contained above is true and correct., I
understand that the Building Division accepts the Application, along with the plans and specifications and other data
submitted by me or on my behalf (submittals), based upon my certification as to accuracy, Assuming completeness of
the submittals and approval of this Application, a Building Permit will be issued granting permission to me, as Owner, to
construct the structure(s) and facilities detailed on the submittals reviewed by the Building Division. ln consideration of
the issuance of the Building Permit, I agree that I and my agents will comply with provisions of any federal, state, or local
law regulating the work and the Garfield County Building Code, OWTS regulations and applicable land use regulations
(County Regulation(s)). All County development requiring a permit, except for residential uses, are subject to Article 7 of
the Land Use and Development Code. I acknowledge that the Building Permit may be suspended or revoked, upon
notice from the County, if the location, construction or use of the structure(s) and facility{ies}, described above, are not
in compliance with county Regulation(s) or any other applicable law.
I hereby grant permission to the Building Division to enter the property, described above, to inspect the work. I further
acknowledge that the issuance of the Building Permit does not prevent the Building Official from: (1) requiring the
correction of errors in the submittals, if any, discovered after issuance; or (2) stopping construction or use of the
structure(s) or facility(ies) if such is in violation of County Regulation(s) or any other applicable law. Review of this
Application, including submittals, and inspections of the work by the Building Division do not constitute an acceptance
of responsibility or liability by the County of errors, omissions, or discrepancies. As the Owner, I acknowledge that
responsibility for compliance with federal, state and local laws and County Regulations rest with me and my authorized
agents, including without limitation my architect designer, engineer and/ or builder.
I hereby have read and understand the Notice and Certification above as well as
have n which is correct and accurate to the of my knowledge
-Ifuh>eyttoDdL
Property Print and Sign Date
t}{r, €IILcSrc*J ,AyD DvSf c.cxynfrOL fzmr-r,fZd
G^>3,TQro,,*'Rr-,U
Special Conditions:t\S- r'f Tl+1t c+-vf.lG1(J -.-rpl tvl . Dr..r,apr \r$
€tt (5 t>T'l L rT! La c^T€
Misc Fees:*'13b.oo A,OFees Paid:(oo -'*73'o oo
lssue Date:*Tu\Balance due:Gradins Permit:
C"[+b' -f,4s;,
L-rq-24BUILDIN6 / pLANNING DIVIS]ON I
DateSigned